CHEST Guidelines-Interlobular-Septal-Thickening-in-a-Young-Man-With

Interlobular-Septal-Thickening-in-a-Young-Man-With

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The article discusses a case of a 30-year-old man with a history of asthma, smoking, and methamphetamine abuse who suffered from progressive dyspnea and eventually required intubation due to acute hypoxic respiratory failure. His symptoms persisted despite treatments for pneumonia, and radiological examinations showed interlobular septal thickening, ground-glass opacities, and pleural effusions, leading to various differential diagnoses including infectious processes and connective tissue disease-related interstitial lung disease.<br /><br />Despite broad-spectrum antibiotic treatment and corticosteroids, the patient did not improve and eventually passed away after his family opted for comfort care due to the poor prognosis. An autopsy revealed pulmonary lymphangitic carcinomatosis secondary to primary lung adenocarcinoma with pseudomesotheliomatous spread. Tumor infiltration was noted in the lungs, pleura, lymphatics, and distant sites such as adrenal glands.<br /><br />Pulmonary lymphangitic carcinomatosis (PLC) is a rare but aggressive form of cancer characterized by tumor cell infiltration into the lymphatic system. It is primarily associated with adenocarcinomas from various primary sites and carries a high mortality rate, often progressing rapidly and with a poor prognosis. The difficulty in diagnosing PLC lies in its nonspecific symptoms and imaging characteristics, often mimicking other lung conditions. Diagnosis usually requires a biopsy, and timely identification is critical for effective treatment, which might include targeted therapies and immunotherapy. Advanced imaging techniques such as high-resolution CT scans can help distinguish PLC from other conditions by identifying characteristic patterns like nodular interlobular septal thickening.<br /><br />The case emphasizes the challenges in diagnosing and treating PLC, especially in younger patients where malignancy is typically less suspected. Early detection and understanding the specific radiological and pathological features are crucial for improving patient outcomes.

Keywords

pulmonary lymphangitic carcinomatosis

lung adenocarcinoma

interstitial lung disease

hypoxic respiratory failure

ground-glass opacities

pleural effusions

interlobular septal thickening

biopsy diagnosis

high-resolution CT scan

targeted therapies